I am nominating Rachel Patchel for the Daisy Award on behalf of three healthcare professionals who independently came to me to express their admiration, respect and highest regards for her.

From Charge Nurse

As oncology nurses, we have the daunting task of caring for patients as they transition towards end of life. Even the most experienced nurses will say without a doubt that facilitating this transition is among our most difficult tasks. A couple of weeks ago, Rachel Patchel found herself in this very position. Rachel was caring for a patient (we will call her Jane), who only a few weeks earlier presented as an independent woman needing abdominal surgery. Jane's life was turned upside down when she learned the most dreadful news - she had massive disease with no hope for a cure. Jane, however, wasn't giving up - she wanted to fight. So she did again and again. Over the next few weeks she fought her way through multiple procedures and physical therapy; she fought through severe pain, nausea, fatigue and emotional distress. Her symptoms were so severe they confined her to bed and left her completely dependent on nursing care. Jane no longer could be the independent women she was a very short time ago.

Rachel came to me, her charge nurse, one morning, saying that things with Jane were starting to change and Jane looked even more sick than usual. Rachel was absolutely right. Jane's symptoms were worsening and she was experiencing the physical changes that are consistent with end of life. Rachel, being a novice nurse on Gibson, said to me, "I don't really have any experience with this yet." After seeing her care throughout the day, I'm confident that I was the only one who knew that.

Rachel made all the right moves that day. She recognized the acute changes Jane was experiencing and was not afraid to ask questions about what to expect or do next. She called doctors multiple times to report subtle but very important changes in the patient's status, and got orders for the medications needed to keep the patient comfortable. Rachel supported the extremely large family and helped the doctors explain the dying process. She listened patiently as family members expressed anger and denial, fear and despair. She comforted them, addressed their fears, answered their questions, and helped them understand the painful truth: their loved one was going to die today. She did it all probably with a lump in her throat and a sick feeling in her gut, but nobody could tell. Rachel remained cool, calm and collected all while taking great care of her other patients as well.

From Attending Physician

Rachel Patchel was involved in a very, very challenging case shortly before Christmas. The patient had been in the hospital for over three weeks with advanced terminal cancer and with failing health. There were multiple adult children with different levels of understanding of the gravity of the situation and the patient was still having difficulty coming to terms. Additionally, the family had several small grandchildren in and out of the room all day. Making conversations difficult for explaining the process of death and what to expect.

Throughout it all, Rachel provided compassionate care for the patient who was actively dying and was sympathetic to the family, all while keeping in close communication with the team of physicians and her charge nurse. I was very impressed as she handled such a complex situation with dignity and grace.

From Rachel Pachel RN, BSN

"Taking care of Jane was the best learning experience because she was so sick and dying. I was so nervous only being a nurse for six months. The family was intense and I mean intense and lots and lots and lots of them. The family wanted the patient to go to rehabilitation, but the patient was actively dying. Her blood pressure kept tanking, respirations were shallow, the patient coloring was gray, she was cold and clammy, she had no urine and she kept moaning in pain. I called the attending and notified him of the patients pending death; she is going to die today. I called him multiple times that day and he called me to check not only on the patient, but also the family. I felt totally supported and I remained calm and ready to assist quality of life at the end of life for this patient. Communication could not have been better between the physician and me; we collaborated on everything. I was so excited but so nervous and I honestly felt completely supported by the doctor. He kept calling to check on me and the patient.

This was my first experience telling a patient and family that they were going to die. The patient said to me, "I'm not going to die". The patient was slowly closing down and I knew her life was ending today. The physician and I sat down with the family and patient to say, "Yes, Jane you are going to die today". I felt that the doctor and I were one; we said the same things and agreed on the same treatment plan. The patient did end up dying that afternoon, and the family was comforted by my direct information and appreciated it. By the time I left that night, I knew I made the right decision to be an oncology nurse, this experience verified to me that I made this patient's quality of life at the end of her life the best experience not only for the patient and also family."

From CNL

Rachel Patchel is a true exemplar of the DAISY Award because she demonstrated all aspects of this award; gave compassionate care at 110%, commitment to excellence, proactive leader and strong patient advocacy, she truly made a difference for the patient and family as well and she exceeded all expectations anyone could ask or need.

As Rachel was telling me her story about this patient, her first actively dying patient with this huge dynamic family, she was full of positive energy, dancing around with excitement and recognizing her passion for oncology nursing made a difference in herself.